Provider Demographics
NPI:1740634237
Name:ELSANAA PT PC
Entity type:Organization
Organization Name:ELSANAA PT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAHMOUD
Authorized Official - Middle Name:
Authorized Official - Last Name:ELSANAA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:929-253-2364
Mailing Address - Street 1:28 LAKE DR W
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-5733
Mailing Address - Country:US
Mailing Address - Phone:718-760-8881
Mailing Address - Fax:
Practice Address - Street 1:8609 51ST AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-3923
Practice Address - Country:US
Practice Address - Phone:718-760-8881
Practice Address - Fax:718-760-8880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-20
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038838261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy